1. Celeste Putnam, Lynn Marie Firehammer, & Charlotte Curtis
Pathways to Independence Summit
Promoting Families’ Ability to Manage their Health Care through Family Centered Medical Homes
Celeste Putnam, Lynn Marie Firehammer, & Charlotte Curtis
September 8th

2. Providing Medical Homes
Department of Children and Families has a partnership with the Department of Health to provide medical homes to eligible children in out-of-home care.

3. Objectives Overview of Medical Homes
Understanding that Health Care includes physical, developmental and behavioral health
Understanding Early Steps
Understanding of how to integrate Early Steps into the Medical Home

4. Child and Family Well-Being Outcome

5. Many Children in Out-of-Home Care have Special Health Care Needs
“Children and adolescents in foster care are a singularly disadvantaged and vulnerable population known to be a high risk for persistent and chronic physical, emotional, and developmental conditions because of multiple and cumulative adverse events in their lives” (American Academy of Pediatrics, 2005)

6. Many Children in Out-of-Home Care Have Special Health Care Needs
Research shows that:
39.3% of children birth to three meet criteria for early intervention
41.1% of children three and four required special education services
60 % of children in foster care have a chronic health care condition
90 % have a chronic, developmental or social/emotional/behavioral disorder

7. Goals for Health Care Management
The goal is to work with the Community Based Care Lead Agencies to provide:
A 72 hour initial medical screen
A comprehensive health care evaluation within 30 days
A developmental screen
A Comprehensive Behavioral Health Care Assessment coordinated with physical health care

8. Goals
Have physical and developmental care coordinated by nurse care coordinators in collaboration with the CBC case manager when feasible
Have children’s immunizations
and periodicity schedules
monitored
Provide health care assistance
in permanency planning

9. Medical Homes Each child will be have a primary care provider
Medical Homes are distinct from Medical Foster Homes

10. Medical Homes A Medical Home is: Accessible in the Community
Family Centered
Continuous
Comprehensive
Coordinated
Compassionate
Culturally Competent

11. Developmental Screening and Referral to Early Steps
The Health Plan should address the child’s developmental status
One approach would be for a nurse care coordinator to work with the CBC care manager, family and others to determine if the child requires a developmental assessment
The nurse care coordinator may make the referral to Early Steps

12. What is Early Steps?
Infants and Toddlers with Disabilities Program of the Individuals with Disabilities Education Act (IDEA) Part C
Created in 1986 to:
enhance the development of infants and
toddlers with disabilities
minimize potential developmental delay
reduce educational costs to our society
by minimizing the need for special education services as children with disabilities reach school age

13. Early Steps Early Steps is Florida’s Part C system
Program administration and over site is in the Department of Health, Children’s Medical Services
16 private contractors (hospitals, universities, community agencies, etc.) provide the day-to- day system in 15 Local Early Steps catchment areas that cover all 67 Florida counties

14. Early Steps Goal
The goal of Early Steps is to improve the developmental outcomes of infants and toddlers age birth to 36 months with developmental delays and established conditions
Families and caregivers are provided with services and supports
to enable them to
enhance their child’s
development within
their everyday routines,
activities, and places

15. Established Condition Eligibility
Categories of established conditions are:
Genetic and metabolic disorders
Neurological disorder
Autism Spectrum Disorder
Severe attachment disorder
Significant sensory impairment (vision/hearing)
Infants who weigh less than 1,200 grams at birth

16. Developmental Delay Eligibility
Developmental delay must meet or exceed:
1.5 standard deviations below the mean in two or more developmental domains or
2.0 standard deviations below the mean in one or more of the domains

17. Developmental Domains
Cognitive
Physical (including hearing and vision)
Communication
Social/emotional
Adaptive

18. Referrals
Local Early Steps (LES) conduct Child Find activities through community health fairs and similar events to identify potentially eligible children
Children are referred to Early Steps from many sources – such as birthing hospitals, CAPTA, pediatricians, child care centers, Early Head Start, Healthy Start and self-referrals
Florida Directory of Early Childhood Services links callers directly to LES

19. Child Abuse Prevention and Treatment Act (CAPTA)
Ensures children under the age of three who are involved in substantiated cases of child abuse or neglect, and are potentially eligible for early intervention services, are referred
Florida has defined “substantiated” as any case with verified findings of child abuse or neglect

20. CAPTA Referral 1
Children who will remain in their parents’ or legal guardian’s home without referral for service are referred to Early Steps by the Child Protective Investigator handling the case

21. CAPTA Referral 2
Children who will remain in their parents’ or legal guardian’s home and are referred for services, will be referred to Early Steps by the CBC lead agency child welfare case manager, if certain delays are suspected

22. CAPTA Referrals
Plans are for children who are being placed into out-of-home care to receive an initial screening during comprehensive health assessment process
The decision to make a referral to Early Steps should be made during the health plan development process

23. CAPTA Referrals
Other indications of a developmental delay may also result in a referral
If available, the nurse care coordinator should assist the care giver and the CBC Lead Agency case manager to access Early Steps
Special attention should be given to substance exposed newborns, and low-birth weight infants

24. Individualized Family Support Plan
Early Steps services are based on evaluations/assessments, and family concerns, resources, and goals
Information about the child and family, including authorized services, are captured on the Individualized Family Support Plan (IFSP) which is required under 34 CFR
Early Steps uses a Team Based Primary Service Provider approach

25. Individual Family Support Plan
The development of the IFSP should include the nurse care coordinator and the CBC case manager
Recommended services and supports should be integrated within the other services provided to the family
Service delivery schedules should be coordinated, especially home visiting programs

26. Team Based Primary Service Provider
Aims to empower each eligible family by providing a comprehensive team of professionals from the beginning of services through transition at age 3
Services are provided where families live, learn and play, to enable them to implement developmentally appropriate learning opportunities during everyday activities and routines
Most services will be early intervention home visits

27. Team Based Primary Service Provider
For children in out-of-home care the team should have access to early childhood mental health therapists
Social, emotional and behavioral early intervention services should be coordinated with other mental health services provided

28. Early Intervention Home Visits
Goal is for the family to
receive strong support from one person
be provided a comprehensive team of professionals
have fewer appointments and more time to be a “family”
Coordinated with other in home services

29. What does Early Intervention Look Like?
Video made available by the Connecticut Birth to Three system and is posted on the Florida Early Steps website for parents to view

30. Summary Children should receive coordinated health care
Coordination of care will
include physical health
care, developmental
interventions and mental
health services
Early intervention services
must be coordinated with the overall health care

31. Integration and Coordination
Planning processes and documents such as the IFSP, the health plan and the case plan must be integrated and coordinated to ensure that:
Services are in support of the permanency goals
Services are coordinated and made easily manageable for the care giver
Services address the needs of the immediate care giver and the biological families if appropriate

32. More Information on Early Steps
Early Steps Website at

33. Questions